Written by Kimiko Dunbar
Spoon Feed
Children with wheezing on admission in bronchiolitis are more likely to have severe illness, recurrent wheeze, and a diagnosis of asthma at long term follow-up.
Will my child develop asthma?
Wheezing is commonly present for patients admitted to the hospital with bronchiolitis. While guidelines are clear about judicious use of bronchodilators in this population, data are lacking on the long-term implications for those who wheeze. This prospective cohort study investigated whether wheezing on admission predicts bronchiolitis severity and future asthma. Among 668 Chilean infants hospitalized for bronchiolitis, wheezing at admission was associated with more severe illness (e.g., oxygen need: 90.7% vs. 78.5%, p < 0.001), higher recurrent wheezing at 12 months (55% vs. 38.3%, p < 0.001), and increased asthma at 4 years (30.1% vs. 21%, p = 0.01). Authors suggest that grouping patients according to wheezing vs. non-wheezing phenotype and RSV vs. non-RSV can predict disease severity. This study only included hospitalized children, so results cannot be applied to wheezing patients with more mild disease.
How does this change my practice?
As a pediatric hospitalist, I see a lot of patients with recurrent bronchiolitis admissions; many of them also have recurrent wheeze. Given their increased risk for readmission, more severe presentations, and development of asthma, we should be more proactive in this population. For patients with recurrent wheeze, I’m more likely to start inhaled corticosteroids as a preventative measure and refer to pulmonary. Many large academic centers also have “early wheeze” clinics to monitor this specific population.
Source
Wheezing on admission: a marker for bronchiolitis severity and asthma development. Pediatr Res. 2025 May 3. doi: 10.1038/s41390-025-04096-9. Epub ahead of print. PMID: 40319140
